I have Keratoconus, should I have a Transplant?

Thousands of keratoconus patients each year are advised by their eye doctors to get corneal transplant surgery (keratoplasty). The great majority of this patient population in reality would do quite well with properly fitted scleral lenses. Keratoplasty is not a “walk in the park.” There are real risks associated with this procedure. The following are the facts associated with keratoplasty:

1. Over 50% of those patients receiving corneal transplant surgery with need scleral lenses in order to achieve visual acuity greater than 20/50. Contrary to what one might think, these lenses are comfortable and very easy to wear.

2. It will take about 1 year for vision to stabilize.

3. There may be a limited lifespan to the transplanted cornea. Repeated corneal transplant surgery due to rejection and/or infection is the 2nd commonest indication for keratoplasty.

4. There is a risk of life-long rejection (this decreases after the first year).

5. There is a susceptibility to traumatic wound rupture.

6. During the first year after the corneal transplant surgery, anti-rejection eye drops will need to be used. The used of these eye drops may increase the risk of glaucoma and cataracts.

For the above reasons, I always recommend that patients with keratoconus and other corneal conditions consider every non-surgical alternative before getting involved with corneal transplant surgery.

A well designed and fit scleral lens serves 3 functions: A. Protect the compromised cornea from the environment and the blinking action of the eyelids. B. Keep the eye moist as most keratoconic corneas have a dry ocular surface. C. Provide excellent vision along with excellent comfort.

The photo below shows a transplanted cornea with sutures. Do you want to do this to your eye?

These photos are of two eyes that underwent corneal transplant surgery that resulted in corneal rejection followed by infection inside the eye( endophthalmitis ) Sadly the result was permanent blindness. While these events are rare they do occur.

The Wavefront Scleral Lens

The corneal irregularities created by refractive surgeries, such as LASIK and RK, are responsible for ghosting, halos, starbursting, and loss of contrast sensitivity. These "higher order aberrations" may exist on both the anterior and posterior. With aberrometry, the defects of the entire optical system can now be corrected by a scleral lens.

The Wavefront Scleral Lens

Autologous Serum for Dry Eyes

Dry eye conditions are among the most challenging conditions faced by refractive surgery patients. With autologous serum, blood is spun down to plasma, forming an eye drop that helps rehabilitate the cornea.

Learn More about Autologous Serum

Dr. Boshnick on CBS This Morning

See Dr. Boshnick and Dr. Morris Waxler (former FDA chief research scientist on refractive surgery) talk about bad LASIK

Optimum Infinite Gas Permeable Material

I am happy to announce that our Global Vision Rehabilitation Center will be designing and fitting all of our “high need” patients with the Optimum Infinite gas permeable contact lens material. The Optimum Infinite material is the most oxygen permeable material ever to be approved by the FDA. In addition, this newly FDA approved material includes a UV lens blocker. Now for the first time, with certain patients, wearing a scleral lens made with the Infinite material under extended wear conditions can be considered.

SMAP 3D Scleral Lens Design

NEW: Powerpoint presentation on SMAP 3D

Last year we introduced an exciting piece of technology that has allowed us to custom design a scleral lens much more accurately. It is the SMAP 3D, which is a computer attached to a dedicated camera that allows us to obtain a 3 dimensional image of the entire front surface of the eye, including the cornea and the surrounding white portion of the eye (the sclera). Up until now there has not been any technology that would allow us to measure the ocular curvatures outside the cornea. The SMAP allows us to do this. Read More

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Blurred Vision, Burning Eyes: This Is a Lasik Success?

EyePrint Pro

EyePrintPro technology creates a scleral lens based on a mold of the cornea. The molding is accurate to 1 or 2 microns and fits perfectly because it exactly mirrors the irregularities of the individual corneal surface. The technology is well suited for post-Lasik, Keratoconus, RK, eye injury, and corneal transplant patients. Read More in this PDF about EyePrintPro Scleral Lens Technology

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